The magically creative tension between extreme caution and (almost heroically bold) self-trust

In the comment section following the last post, a fruitful dialogue sprang up between Matt (the author of the post) and Cheryl, a reader. In a comment following his post, Matt admonished us (addicts, ex and otherwise) to remain aware of our vulnerabilities (like fluctuating willpower, loss of perspective), to not get too cocky, to continue to remind ourselves that we still think and feel and even act like an addict. Cheryl’s response was a sort of call to arms in the other direction — an invitation to shut down the voices of self-doubt and take stock of our strengths instead. To trust in those strengths, to dive into that pool of self-trust without looking back. These approaches to recovery sound almost diametrically opposed. Yet it seems to me there is  some crucial truth in the space between (or stretching to include) both of them. In fact, this could be one of those magical tensions. Like wave-particle duality, or the impossibility of life without death, or the fact that humans are both totally selfish and totally altruistic — the kind of tension that gets you thinking more deeply about a topic than any one perspective ever could.

The sort of self-trust that Cheryl mentions is, I think, similar to what I was trying to emphasize in several posts, including this one, nearly a year ago. I was pointing to a special kind of power in self-trust that turns up its nose at the reminders of past failures, to the shame and guilt that go with them, and to the moralistic (and sometimes, hate to say it, but realistic)  judgements of others, those judgements that jumpingbounce round and round inside our minds in self-defeating rumination. That kind of total self-trust is a lot like hope, in that it’s at least partly irrational, maybe even deluded in the grand scheme of things, but absolutely essential to moving forward, potently, effectively, without looking back, eradicating that massive tangle of self-defeating habits in one giant twist rather than a bunch of little adjustments.

cautionAnd yet — hey, we’re not idiots! — after what we’ve been through (i.e., addiction) we’ve learned a thing or two. We know the value of staying on top of the little things, continuing to evaluate just how vulnerable we might be in certain contexts (like the aftermath of rejection or loss, driving past a particular neighborhood) and situations (like parties, especially when things get a little late) where the dangers lurk. Even little dangers, because they can easily blow up into big dangers. We’ve learned to remain cautious car.dogso that we can avoid those dangers before they spring up in front of us. Like a dog suddenly caught in the headlights of a speeding car, it’s too late for the dog, given that we didn’t start slowing down half a block away. This view has a lot in common with the concept of “self-programming” that I got into a few posts ago, and that Jeff Skinner and Shaun Shelly have also remarked on in different ways.

I quote my esteemed self from that post:

Proximal intentions don’t matter. By the time you are getting close to the point of action, the dye is already cast. Setting up intentions in advance is called “self-programming” by [a philosopher named...] Slors, and I think that’s a great name for it. You are indeed programming your own future, by changing contingencies, determining circumstances, setting up non-negotiable outcomes. You are programming your life, and your brain, and your environment…

As Matt says, it is really crucial to stay ahead of the game, i.e., to adjust your speed, or pick a different route, before you hit the dog, before the urge (and/or the opportunity) to use is staring you right in the face.

Come to think of it, both those strategies — total self-trust and vigilant self-monitoring — so seemingly opposite, are resolutions to the fundamental problem of delay discounting…or to put it more colorfully, the problem of being stuck in our over-the-top attraction to the IMMEDIATE FUTURE, at the expense of long-term contentment. If you’ve followed this blog, you might remember how I went on about the role of dopamine — which geysers in our nucleus accumbens when addictive “rewards” become present, possible, available. I claimed that an unfortunate side-effect of dopamine is to exaggerate the (perceived) value of immediate rewards (e.g., a few lines of coke in half an hour; a chocolate cheese cake for dessert) while “discounting” the importance of future outcomes (e.g., being broke, fat, and/or increasingly addicted).

So….isn’t that cool? These opposites — whose tension feels creative, productive, maybe even necessary — are both good answers to the same question: how do you free yourself from the fierce and unpredictable tug of the immediate future? Do you trust yourself and thereby project yourself directly into the future you really want, or do you slow down and turn up the vigilance dial by remaining painfully aware of your past?

I could try to collapse this tension by saying something like: trust yourself to be exactly as cautious as you need to be… But some tensions are more creative when left alone.

48 thoughts on “The magically creative tension between extreme caution and (almost heroically bold) self-trust

  1. Valeria March 7, 2014 at 6:15 am #

    Great post Marc!!!
    In my opinion our past is always a good teacher…From the past we can learn how to avoid our mistakes…

    • Pete March 7, 2014 at 5:06 pm #

      Ditto Marc :)

  2. Julia March 7, 2014 at 10:42 am #

    Marc, I think this is the perfect segue from the last few posts which focused on what sorts of treatments are best, how to define addiction, recovery, etc. All those are external to the subjective experience of the individual. And no matter what those externals say (and they hardly ever agree anyway), one still has to figure out how to live with oneself. This post puts the dynamic tension of what goes on inside us so well.

    The dance between various forces, some internal, some external and what happens when they interact is constantly in motion. The individual is always the operative factor. Some people recover despite really bad treatment, or none and some never do despite the seemingly best circumstances.

    Is there some secret? Some magical universal that, when it’s identified, can be replicated and applied universally? I don’t think so but that isn’t to stop others from looking! It helps me to have as much information as I can about the latest theories and practices. But those are constantly being revised anyway, and probably will be for a long time to come and are just a subset of the larger questions about consciousness, free will, identity, etc. Who knows when we will ever get a good handle on them!

    But getting back to addiction and recovery, however you define it. I’m a big fan of trying to cultivate an attitude of curiosity and learning from negative experiences rather than using them as reasons to blame ourselves or give up hope. What I mean by that is to accept that life is a continuum and that it’s not over until it’s over (meaning when you die).

    We are each our own experiment in living. What works for us? What doesn’t (even though it did for someone else, or may work later)? Exploring why we fell off the wagon that particular day or place and using that information to plan differently in the future. Taking time to step back and take a longer view, to acknowledge our progress or growth, our successes, especially the ones that may be invisible to others. And to marvel at “how did I do that!?”

    It’s impossible to compare one person’s life to another’s and say who had the harder time, who overcame the most obstacles, who could have done this or that and it would have been different. I often fall into the trap of only seeing a snapshot of the present and comparing myself to others of the same age and (apparent) background and feeling like a failure.

    But when I look more deeply and remind myself of what I have gone through, what I have overcome, where I have gotten to in relation to where I WAS, I am pretty proud of myself. Most of those things will never show up on a resume or even come up in casual conversation. But that doesn’t make them any less important than my current demographic stats.

    So that inner tension/balance, constantly moving and evolving process you describe so beautifully, Marc, is very much of the essence. As you write, it’s hard to describe in any objective, concrete terms. But all the more reason to reaffirm its centrality, to ourselves, to those around us, to the institutions and experts that expound and classify us from the outside. It’s also a reason I’m such a fan of bring out individual stories. No one is the same and yet each is universal in its uniqueness and potential to inspire, educate and reassure others.

    • Matt March 7, 2014 at 3:12 pm #

      So true Julia. I think those whose mettle was tempered in the crucible of recovery acquire a unique inner strength. It’s not a way I would ever recommend for anyone to get to know themselves better, but that is one of the hard-won benefits.

      • Pete March 7, 2014 at 4:54 pm #

        Well put Matt :)

        • shaun shelly March 8, 2014 at 10:23 am #

          True Matt, and there is some neuroscience beginning to demonstrate that. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0059645
          What is amazing, is that in certain areas, after 35 weeks of abstinence, the gray matter density of a recovering addict exceeds that of a drug naive subject. Not only this, but there is asymmetry between the losses and gains, pre and post use. This would imply that recovery does not simply reverse the affects of drug use but involves distinct neurological processes.

          • Marc March 9, 2014 at 5:36 am #

            Shaun, was it you who sent me this paper? I refer back to it often. Let’s keep our eyes open for any replication — or, we could contact Garavan, the senior author, directly. I was in touch with him years ago.

            • shaun shelly March 9, 2014 at 6:37 am #

              Yup, I sent it to you a while back. Also very interested to see replication.

          • Matt March 11, 2014 at 12:21 pm #

            Some kind of learning, I’d imagine. There’s the other side, where alcohol may impair learning associated with fear extinction, and exacerbate, and possibly increase the generatively of anxiety disorders related to trauma. Are you following any of this work?

            NATURE NEUROSCIENCE | BRIEF COMMUNICATION

            Chronic alcohol remodels prefrontal neurons and disrupts NMDAR-mediated fear extinction encoding
            • Andrew Holmes, Paul J Fitzgerald, Kathryn P MacPherson, Lauren DeBrouse, Giovanni Colacicco, Shaun M Flynn, Sophie Masneuf, Kristen E Pleil, Chia Li, Catherine A Marcinkiewcz, Thomas L Kash, Ozge Gunduz-Cinar & Marguerite Camp

            Nature Neuroscience 15, 1359–1361 (2012) doi:10.1038/nn.3204
            Received 14 June 2012 Accepted 02 August 2012 Published online 02 September 2012
            Alcoholism is frequently co-morbid with post-traumatic stress disorder, but it is unclear how alcohol affects the neural circuits mediating recovery from trauma. We found that chronic intermittent ethanol (CIE) impaired fear extinction and remodeled the dendritic arbor of medial prefrontal cortical (mPFC) neurons in mice. CIE impaired extinction encoding by infralimbic mPFC neurons in vivo and functionally downregulated burst-mediating NMDA GluN1 receptors. These findings suggest that alcohol may increase risk for trauma-related anxiety disorders by disrupting mPFC-mediated extinction of fear.

            • shaun shelly March 11, 2014 at 12:35 pm #

              Thanks Matt, will look at this some more. Was aware of some of this, but haven’t looked into it in detail.

            • Marc March 17, 2014 at 3:36 am #

              Hey, this is pretty interesting. In my book I shamelessly oversimplify the effect of alcohol on the brain. But one thing it surely does is to increase GABA firing while it decreases glutamate metabolism. So it increases inhibition (in brain, not behavior!) while shutting down activation all over the cortex and limbic system. If you can’t process memory by replaying events in your mind, then you can never modify what you’ve already learned.. So it makes sense that traumatic memories would stay intact.

              Of course all this skirts the obvious: alcohol relieves stress, PTSD is a kind of stress. So alcohol does help relieve PTSD, but only for the moment.

    • Marc March 9, 2014 at 5:32 am #

      Beautiful and captivating essay, Julia. You may not be able to crow about these victories on your resume, but this blog is one place where you can. I think much of what you say can be summarized as another dynamic tension: that between uniqueness and universality. Yes, we recover in highly unique ways, but there is something universal about the process that we recognize from each other’s stories. Since we’re all being quite philosophical now, I can say that your dynamic tension and mine seem to cover much of the same space. That’s a mind-bending image.

  3. shaun shelly March 7, 2014 at 12:42 pm #

    I have stated before that I seldom see balance as being obtained by living in the middle ground. It is best found by embracing the extremes. Certainly my life has taught me this! I have also stated that the view of mutual exclusivity is very seldom helpful or true, and almost never when it comes to addiction.

    Traditional treatment methods have taught us that we never recover, that we always have to be vigilant. I believe that there is a subtler truth in this – as Kent Berridge has shown in his experiments, most of us will be sensitized to the drug, environment and stress. But this is true for all of us, not just addicts. If we have found a measure of relief in a particular relationship, in times of stress, or in a particular situation we may find ourselves making a late night call even though we know the outcome will not have a long-term positive outcome!

    But simultaneously most of us have developed more beneficial coping mechanisms in the recovery process. Many of these are internal. We can trust our feelings and warning signals. We trust the mechanisms we have put in place. We trust our new relationships, both with self and others. Of course, when these relationships fail, or we perceive them to be failing, this is when vigilance is needed.

    So yes, I find myself in this intricate dance between absolute self-trust and knowing when I am vulnerable.

    • Matt March 7, 2014 at 2:46 pm #

      Isn’t “embracing the extremes” sort of the meaning of balance? The middle ground?

      • shaun shelly March 7, 2014 at 5:57 pm #

        Matt,

        I find many people consider their views “balanced” by standing firmly in the middle ground, ie by not venturing too far from the “safe””territory of conventional/popular opinion. They do not explore the apparent polar opposites. Personally I believe that we need to fully understand and immerse ourselves in these seemingly juxtaposed or seemingly opposing positions before we are able to achieve some form of meaningful balance. This, for me, is not the same as taking the middle ground.

        • Matt March 7, 2014 at 7:45 pm #

          Thanks, Shaun
          That makes perfect sense. I just wanted to clarify. I was thinking that by embracing the extremes it is all encompassing, so you have a balanced view. Not the cloistered middle ground. I’m with you.

          • shaun shelly March 8, 2014 at 10:17 am #

            We agree then. Actually, there is a logical fallacy called “middle ground fallacy”, which I was not aware of until a few months ago, so I was glad to hear that I wasn’t the only one to think this! This site is a nice little reference to logical fallacies: https://yourlogicalfallacyis.com/

            • Matt March 8, 2014 at 12:34 pm #

              Nice!! Excellent site. Thanks for the link, Shaun…

            • Marc March 9, 2014 at 5:55 am #

              Wonderful site! I just identified three that my wife and I use when we bicker. When I showed them to her (granted, she had just woken up) she engaged in total disinterest. Is that another logical fallacy? I doubt it.

              I wish there was a kids’ version.

  4. Matt March 7, 2014 at 4:13 pm #

    “Total self-trust and vigilant self-monitoring”….I might argue that there is a state of overarching “meta-” clarity and self-knowledge where these are essentially the same thing. Ask the Dalai Lama. The seamless integration of what Danny Kahneman calls the fast and the slow mind. But how do we get ourselves there in recovery? In “Denial,” Varki and Brower propose a similar state as the reason we became the dominant species on the planet. In the same way we selectively deny negative consequences leading to ruin (maintaining addiction), we also have to deny negative consequences (withdrawal, etc.) and the broad relief the addictive behavior provides, when pushing toward recovery. Denial goes in both directions. We just don’t like to think of it that way.

    This brings me back to the waste of resources in the bickering over who’s right in recovery. If we could get everyone to do a little thought experiment:

    Let’s say tomorrow, SMART Recovery changed its philosophy (but not its practice), to accept that people were powerless over their addictive behavior because in studies it was shown statistically to give people better odds at success. What would it do to people in solid recovery? Would they start to believe they were actually “powerless” and go out and get drunk? Probably not. The notion of powerlessness, or the insistence on choice means nothing without the personal resolve to back it up. No matter the connotation of “powerlessness” and “acceptance”— using has become life-threatening, not life-affirming and all the contention about the right method is superfluous.

    Or better yet, as the younger generation gradually outnumbers the old guard of AA, they decide to make some changes to make the group more appealing to a diverse population including atheists, behaviorists, even moderationists— the range in inclusiveness of different beliefs. Since everybody else is embracing the new research on powerlessness, they’ve decided to become the empowering program they always knew they could be with just a little philosophical tweaking….

    Both plausible outcomes from what we know of humans and their drive for belonging and resistance to change.

    I think the real sea change in all this is the trend toward inclusivity of right views, not the exclusion of “wrong” ones.

    • Cheryl March 7, 2014 at 7:00 pm #

      I think the sea of change needs to focus on the end goal. The end goal cannot, in my opinion, be sobriety……that just isn’t enough. The end goal has to be a value in a life worth living. With that being the end goal the possibilities for inspired change are endless and can or may include abstinence, harm reduction, self love, self trust and more. Everyone has a different idea of what type of life is worth living for them and its worth it to personally Explore, Dream, Hope and create. This type of creating adds to a person, a community and a society at large. It focuses on the solution rather than magnifying the problem.

      • Matt March 7, 2014 at 8:36 pm #

        Absolutely. Sobriety is a stepping off point, not a goal. Attention to medical, mental health and quality of life issues is the goal. Getting an unhappy person sober doesn’t make them happy. But it can allow them to take the next step on their own and take charge of their life. There needs to be more.

      • Marc March 9, 2014 at 5:59 am #

        You two make a great team. Seriously, you’ve covered most of the really big meta issues, including the issue of getting away from the meta scale and back to reality :–)

  5. cheryl March 7, 2014 at 4:55 pm #

    Marc, thanks for beautifully and clearly interpreting my response “Cheryl’s response was a sort of call to arms in the other direction — an invitation to shut down the voices of self-doubt and take stock of our strengths instead.”

    Julia, your statement ” I often fall into the trap of only seeing a snapshot of the present and comparing myself to others of the same age and (apparent) background and feeling like a failure.” perfectly describes, to me, the next rabbit hole many seem to feel it necessary to go down after some clarity and success with abstinence and it couldn’t be more self defeating. It is nowhere near a real snapshot of who that person is.

    I really feel that treatments today and in the future need to teach reframing of who a person is because if you have gotten yourself to the point of addiction I feel sure a lot of poor framing came before it. To teach it would mean an engagement in the reframing process of most treatment centers and support groups. I feel sure it will take the recovering addicts to make this happen because treatment centers are thriving whether their clients do or don’t. In my opinion through observation there are 95 to 98% of clients that are not getting the real tools of self trust, self esteem, resilience training and or reframing to see real future personal options that allow one to thrive. As Marc pointed out these are tools of hope and right now many of the tools now offered are based on fear.

    • Marc March 9, 2014 at 6:29 am #

      I find your perspective very compelling, Cheryl. This business of reframing…well it’s an endless road, isn’t it. One of the steps seems to be the acknowledgement of impermanence (as the Buddhists say) and acknowledgement that we cannot escape from the present tense, which very often does include some suffering. To me, these reframing realizations have a lot to do with moving on from addiction.

  6. cheryl March 7, 2014 at 5:30 pm #

    I would also add that I find it disturbing that the MN model of treatment and the 12 steps are so ingrained in our society that judges court order treatment based on the 12 steps and the attendance of a 12 step support group in drug and alcohol conviction as if no other treatments or support groups exist.

  7. William Abbott March 8, 2014 at 6:31 am #

    I would like to point out to the ” esteemed self” here that ” dye” is something we use to change color whereas it is a ” die” that that is to be cast . Kind of what J Caesar did when he crossed the Rubicon.

    Ive posted here about my hope to shift the idea of addiction away from escaping or avoiding past problems. This minimizes the worry about ” disease’ , and shifts the focus from negative past problems as is the drone of AA meetings to positive things in a balanced and better life .

    And this is Smart speak

    • Matt March 8, 2014 at 5:06 pm #

      Good idea. But it’s a little hard to arbitrarily shift topics in a blog. That’s their bane and their beauty. They’re organic, and morph and take on a life of their own. Yet they are tractable and follow a logical progression. Similar to the way we can understand the meaning of a phrase, even if it has typos in it. Why don’t you work SMART’s positives into some of the observations of how people are using the past to learn from, and these experiences used inclusively to make better decisions about treatment options in the future

      • Marc March 9, 2014 at 6:13 am #

        Lovely rejoinders, Matt.

    • Marc March 9, 2014 at 6:11 am #

      First point taken, though see http://www.wordwizard.com/phpbb3/viewtopic.php?f=7&t=18414 for an alternative.

      Second point: Sounds like you agree with Cheryl’s and Matt’s perspectives…and mine too. You agree? Right?

      • William Abbott March 9, 2014 at 8:02 am #

        Not sure about banes and beauty of blogs but I agree we agree and thats a good thing to be so agreeable

        • Matt March 9, 2014 at 9:52 am #

          Agreed.

  8. NN March 9, 2014 at 4:35 am #

    What’s odd about ‘delay discounting’ as a issue is this. Humans seem to get caught
    up, and maybe should learn ‘self trust’ or visualization of long-term goals. Yet
    animals do it all the time. They don’t seem to need to give (self) pep talks about longterm goals or make themselves repeat “you’ve got to trust yourself.”

    They generally seem to keep longterm goals ‘in mind’ (whatever that means–on the
    back burner if not the front). Important tasks like the bird’s building a nest or a female mammal looking after babies, or going out to see food for them seem to get
    carried through. If there are distractions (delectable piece of food), they only momentarily interrupt the ‘larger’ tasks.

    I don’t know the answer, but animals seem to have a task hierarchy. Even rats who got to like cocaine can–outside lab constraints–get themselves to other tasks.
    How the human hierarchies get messed up in certain cases, I don’t know. Perhaps that’s worth calling a disease or something like it if a person doesn’t do the essentials (e.g getting out of bed in the morning). But how did he get this way?

    • Marc March 9, 2014 at 6:36 am #

      Very interesting about a task hierarchy or nested goals. Indeed this does seem to be one way to defeat delay discounting. But the problem is that DD really cuts through logic and rationality and realism and all the rest. So the hierarchy has to be deeply ingrained….as I think it is for animals, in terms of their larger goals, like taking care of their young. In fact that seems to be the “purpose” for altruism and even self-care to be expressed as emotional primes rather than learned achievements.

      And you’ll be interested to know: animals also fall victims to DD! Not only mammals, but even birds — pigeons if I remember — will go after the more immediate goal even when it’s worth less than a slightly longer-term payoff. I can’t remember where I got that factoid. Probably from Ainslie’s wonderful book.

  9. JLK March 10, 2014 at 12:56 am #

    Hi Marc

    Yes I am still here. Have been dealing with a remark one of my (many) Drs made that with the illness I have mentioned before I have only a few years to live.

    That said I am wondering how one looks further into the future when the tendency is to try to enjoy, as much as my brain will let me, every day as it comes. I remain sober primarily for the benefit of my wife and 2 daughters. I certainly can’t do it for myself as I have a limited shelf life and the tendency to remember the “good times” drinking become stronger with each passing day.

    My wife has said that my illness, now in its 56th year has worn down the workings of my body prematurely so each day/week/month brings a new source of pain whether physical or psychological..Arthritis has now put a new hip in my near future after years of hip and lower body pain..

    I don’t meant to sound whiney but I have to wonder how people in my position could possibly do what is suggested. Even after 11 years sober it is still one day at a time with constant white knuckling in order to keep my family together while I still have the ability to be remembered in a positive light. The last thing I want is to be recalled as a drunk. But the future, beyond tomorrow, has very little meaning to me..

    The irony is that I have everything people think they want…. a loving family, money etc but without the ability to enjoy the fruits of my labors it is all a handful of dust.. The future, self confidence yadda yadda are all Greek to me. I hope that I am in the tiny minority.

    JLK

    • Marc March 10, 2014 at 4:21 am #

      John, this is really rough. Shall I get back to you here on the blog? Or by private email? The question is, I guess, whether you want others to pitch in. Well, I guess you’ve already invited the whole team. And indeed you bring up a problem that is in some ways universal, though for you it is acute and concrete. For others, still abstract.

      I’ll leave it at that for the moment. But I’ll just add that I have fantasized many many times about whether I want my last months to be clear and relatively cogent or else floating in opiate dreams. You’re talking years, not months. But still…

      More soon.

      Marc

      • JLK March 10, 2014 at 10:41 am #

        Hi Marc
        After I hit “send” I kind of regretted it for several reasons.
        The first would be the tone of the letter. I have spent almost a lifetime (all but 11 years ) battling this disease/disorder. As I have mentioned before it came from a bout with a killer disease: MRSA Staph. There had been many a time when I had longed for death but I have always done my best to cover it up. In the old days it was fear of being accused of hypochondria. I have seen a dozen shrinks who have given me a dozen (bad) diagnoses. One even tried to treat me with dylantin. Who knows what he was thinking.
        But the one common thread was I saw no reason to share my pain with others. Why? What good does it do. Am I trolling for sympathy?

        The second reason was it seems like it has no place in your conversation. When I “recovered” (you NEVER recover it turns out) from MRSA (less than 5% back then, 40% now) I immediately became “different” So my bout with alcoholism and many other sundry diseases/disorders has a history that is PHYSICAL and not psychological although my father dying one month after I recovered did not help. It also threw diagnoses into a cocked hat because the shrinks assumed that was the cause. I had to wait to find the true cause until several years ago when a number of research projects began to correlate. They finally even gave it a (stupid) name in DSM 5.

        As I babble on I need to wrap it up by saying you’re good to go on publishing but only if, in your judgment it will help the conversation. If it is too far afield (not myself lately anyway) then just “86″ it.

        Rgds
        JLK

        PS On a lighter note: Have you heard that “eh” has been jettisoned up in BC at least, for “Holy” pronounced phonetically something like “huuly”. You have been gone a long time and I talk to the guys up there almost daily.

    • Marc March 11, 2014 at 7:32 am #

      Well it seems we are conversing on the blog. So be it. I hope, then, that others will have something to say that might help.

      So the question is: do we evaluate the fruits of our labours in terms of years of life expectancy, or in terms of present levels of good and bad feelings (images of the good times vs. the shame and pain of alcoholism), or even in terms of how others will remember us. I think the question is so difficult when it comes to addiction, because it is the extreme version of another, larger question. As noted in my post, I think it is much more easy and natural to “stay clean” if you can connect with a future self and feel a sort of two-way relationship with that self. You trust in your future self, and you become your future self, and that stretches well past the immediate gratifications of getting intoxicated on a single occasion, even though that occasion is in the immediate present. It seems, John, that you are staring right into the eye of the “delay discounting” quandary….the future looks even less valuable (than the present) because it is being eroded by a medical “death sentence”….though one that may still be a long way off (let’s hope).

      I feel completely incapable of providing any words of wisdom about such a difficult conundrum. My hunch is that the future need not be the distant future, and so it may be less of a problem than you think. Because getting loaded tonight and tomorrow night will not only downgrade your future happiness in a year or in several years. It sounds like (given your love and your concerns for your family) that even the day after tomorrow and certainly next week will become a quagmire of mixed emotions, topped off by remorse and shame perhaps. So maybe that’s the choice you’re facing. And it’s an easier choice than trying to juggle the balls of today vs. “in the coming few years” (even assuming that your doctor is precisely correct — often they are not).

      That’s all I can think to say for right now. But you have hit the nail on the head as far as the addict’s pocketful of 10 biggest challenges. This has got to be near the top of the charts.

    • Matt March 11, 2014 at 10:21 am #

      This is tough. I marvel at your incredible stamina and perseverance. You’ve come to an insight many in your situation never get to. About how none of this means anything, and it’s what we make of it that matters. Some people suffer horribly, others seem to have it relatively easy, but death comes to everyone, and all the “stuff” that we leave behind is but a “handful of dust” as you say. It’s not the stuff— abstract, material or philosophical. It’s what we do with it while we’re here. That is what we leave behind.

      My wife recently had one of the biggest mentors of her life die of brain cancer. An extraordinarily brilliant and loving man. He actually had the gift of being able to prepare for his own death. But till the end, he just wanted to do more and complete his life’s work. Which of course, is never complete. That’s the purpose, the life essence and the legacy; what others will remember when we pass. It may seem cold comfort, but the best way to allay ones’ own suffering is to help others, and you’ve been doing that intuitively all along.

  10. Suzy March 10, 2014 at 11:58 am #

    I think that total faith in self can lead to delusion and excessive vigilance can lead to getting stuck. Both of which can affect our relationships, activities, and our selves. The former can get us into trouble as we take excessive risks. The latter may result in the troubles of not reaching and growing. Black and white thinking is a cognitive distortion that limits our options.

    Enter the concept of balance. Maybe we oscillate between the two extremes and develop a middle ground. Maybe we manage to play in the middle. In my experience some people who have total self-assurance who are in recovery are a menace to the people around them. They may be screwing up all over the place and remain blissfully ignorant of this. Those who are constantly second-, third-, fourth-… guessing their thoughts, feelings, actions are a danger to themselves as this is a toxic place. Somewhere in the middle lies the sweet spot. I think I’ve fallen in the camp of swinging back and forth. Slowly, I think I’m getting closer to balance. Seems to be a tough to achieve ideal but a worthy goal.

    • Matt March 11, 2014 at 10:16 am #

      Well, I usually feel like hurling violently when I hear others say this, but— I feel your pain. I am a MRSA survivor. Over 27 surgeries worth ( I lost count) and a string of “renowned” surgeons refusing to work on me other than to perform amputation. Through it all, I learned what makes a good doctor. It’s not bedside manner or expertise. It’s that they NEVER give up until you are better, or dead. Between 2 docs, and infectious disease specialist and a gifted plastic surgeon I recovered after almost dying of septicemia— twice. The right surgical approach after trial and error, and the right combination of antibiotics finally beat it. Most doctors feel MRSA is at best a boring and mundane cost of doing business and at worst the looming threat of malpractice. We get mistreated because we are too big to get swept under any rugs. But like the “real” doctors, as humans we can never give up until we are better or dead. I guess that’s what life is, really. Hang in and don’t give up. Recovering from iatrogenic MRSA became my life, for many years. Now it isn’t. Once I accepted that I would never give up like the “good” doctors, my wounds closed and I got my life back.

      • JLK March 11, 2014 at 1:48 pm #

        To Marc and Matt

        Your notes do help. Please don’t think otherwise. In my life’s experience most people don’t have a clue as to how difficult it really is to live with this shit day in and day out. You Marc and especially Matt have shown another side, the good side of human interaction.

        My sister once asked me why I always have this “angry” look on my face. I tried to explain to her that, without knowing why, I had continuous bouts of both Dysthymic and Major Depressive Disorder. Her response? “Just snap out of it”. That was 25 years ago and I have not mentioned it since. That is the other more common response. Another reason to appreciate your responses.

        Because of our conversations I am now going to try and concentrate on my legacy as opposed to my future. It makes sense in my situation and helps take the place of an uncertain future. That is a key piece that I have thought about, but only in passing. Thanks to both for your input especially as it relates to my addiction problems.

        Matt if I can give you one piece of advice. (BTW you are the ONLY MRSA survivor I have ever talked/wrote to). That would be to get your hands on a copy of DSM 5 and look up “Acute Inflammatory Body Sickness” …that is the “stupid” name given my disorder.
        Like Polio, Sepsis ,especially if it reaches the brain, can cause 9 identified symptoms throughout your lifetime.. Average is 3-4 , I have 8. So if brain lesions were part of your horrible experience you should see a specialist in brain chemistry. There are a lot of medications out there some good some not so good, but the right ones (and as you say the right doctor) can help ease any symptoms you may experience.

        JLK.

        PS I even have Anorexia! Sheesh!

        • Matt March 11, 2014 at 3:44 pm #

          I am so sorry for what has happened to you, and I’m happy if this has helped even a little. I remember with my illness, it felt after a while as if I lived in the hospital, which in turn reinforced continuously being in the “sick role.” It was a way of life for years, in many ways analogous to my being an addict/alcoholic. It was what I did. I also had been deathly ill in my early life catching everything from measles to mumps in short order. I missed the first year of school because I had mononucleosis at 4. I eventually learned that having been a DES baby of the ’50s, some of the sequelae included immune system problems. In retrospect, I now see that I learned to be in the “sick” role my entire life, and that just continued on with my addictions. This was the strongest evidence to me for my addiction being a disease, even though it seemed subjective and based solely on my previous experience. But it continued to keep me in the role and coping mechanisms I had been conditioned into since birth. The moment I was able to see how this had been such a maladaptive guiding force in my life, i was determined to break the chain. It didn’t happen overnight, but fueled my determination for things to be different. I truly hope that you can find a way to break your own chain and move into a wider sphere of recovery and move on to what’s next for you.

          • Marc March 11, 2014 at 7:52 pm #

            You guys could make a Coen Brothers movie with a happy ending. I have to read this stuff tomorrow when I can see straight. For right now, I’m very glad that you two “met” and that I can watch from the peanut gallery.

            • Suzy March 12, 2014 at 8:53 am #

              Yes, black humor, we could likely all do this!

      • Suzy March 12, 2014 at 9:08 am #

        I think a doctor who stays with your illness until it is diagnosed and treated is an “excellent” doctor. I’ve known good doctors who don’t. It seems the culture here is for folks to solve their own problems but there is an obvious flaw there in that we are not doctors. I have had doctors respond to my symptoms with, “That’s interesting.” or “Are you still seeing [other healthcare provider].” I saw one doctor who noticed a problem during an appointment and then later said that he didn’t see anything out of the ordinary. I don’t know what the motivation is but I suspect it is partly ego protection, if they don’t own it then they can’t be wrong. In this case my blood pressure dropped significantly while doing a stress test on a treadmill. To the point where the doctor looked shocked and commented. To later be gaslighted about that was demoralizing.

        According to “The Emperor’s New Drugs” there is evidence that good bedside manner results in better medical outcomes even if treatment isn’t given in the conventional sense. It doesn’t make sense for doctors to ignore this and not learn the skill if they don’t already have it. That said, obviously bedside manner couldn’t cure your MRSA but it wouldn’t have hurt the symptoms and outcome.

        I currently have a PCP who is excellent at empathizing and listening. She’s the best doctor I have ever seen.

        In my family of origin I was not noticed unless I was doing very badly. That was conditioning for self-neglect, the antidote of which is self-care. This is perhaps the key to moving forward with my health.

        “Trial and error.” You mentioned that in your post. To get a complex problem sorted out a doctor has to be willing to miss the mark and try again.

    • Matt March 11, 2014 at 5:11 pm #

      The pendulum has to stop swinging eventually if we stop pushing it, right?

      • Matt March 12, 2014 at 10:32 am #

        Awesome points all, Suzy… and a testament to the power we have within us to heal ourselves.

        I think it’s important to admit making a mistake (at least to ourselves, so we can learn from it), but doctors come up in a world where this is looked upon as a sign of weakness. Bad medicine.

        We expect there to be a certain degree of implicit arrogance in doctors, due to the gravity of their occupation and the confidence they want to instill in patients. But if that transforms into hubris…well, we all know where that leads. I also didn’t mean to imply that bedside manner is unimportant, but that it is trumped by due diligence, perseverance and compassion— compassion meaning empathy that moves one to action on another’s behalf. And as any parent can tell you, this may often fall short of resembling good “bedside manner” to the naïve observer….

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

Current day month ye@r *